Cerebrovascular accident complicating acute myocardial infection: incidence, clinical significance, and short- and long-term mortality rates

Article Abstract:

The occurrence of heart attack may be complicated by cerebrovascular accident (CVA), which refers to conditions resulting from ischemia (insufficient blood supply) or bleeding within the brain. A more common term for cerebrovascular accident is stroke. CVA may occur in 0.6 to 8.6 percent of heart attack patients. Anticoagulants, or agents that prevent blood coagulation, may help to reduce the number of emboli, or blood clots in the circulation, but they do not improve death rates due to heart attack. The incidence, risk factors, and clinical importance of CVA or transient ischemic attacks (CVA-TIA) associated with heart attack were assessed in 2,276 survivors of 5,839 heart attack patients. CVA-TIA occurred in 54 of 5,839 patients. The incidence of CVA-TIA increased from 0.4 percent among patients 59 years or less to 1.6 percent among patients 70 years or older. Older age, a history of congestive heart failure, and previous stroke influenced the development of CVA-TIA in the early stage of heart attack. Forty-one percent of patients with CVA-TIA died within 15 days of the attack, 34 percent within one year, and 59 percent within five years. In comparison, death rates among heart attack patients without CVA-TIA were 16 percent at 15 days, 11 percent at one year, and 29 percent at five years. The findings show that CVA-TIA is a rare complication of heart attack. Older age, previous CVA-TIA, and a history of congestive heart failure increase the risk of CVA-TIA in heart attack patients. The development of CVA-TIA in a heart attack patient increases the risk of early death three-fold, and even increases the risk of later death among survivors of heart attack. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Risk factors, Heart attack, Stroke (Disease), Stroke

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Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: a pilot study

Article Abstract:

Congestive heart failure (CHF) is the inability of the heart to pump blood efficiently, resulting in the accumulation of fluid in the lungs. This condition is characterized by weakness, breathlessness, abdominal discomfort, and tissue fluid accumulation in the legs. It is a major cause of death and disability in patients with heart disease. Diuretics, agents that increase the elimination of fluid, are the drugs of choice for treating CHF. However, long-term treatment with diuretics such as furosemide may cause various side effects, such as a deficiency of thiamine due to loss in the urine. Thiamine, also known as vitamin B1, is important for the metabolism of carbohydrates and fats. Thiamine deficiency may also adversely affect the function of the heart. The prevalence of thiamine deficiency was assessed in 23 patients with CHF who were receiving long-term treatment with furosemide. Thiamine deficiency was detected in 21 of 23 patients with CHF treated with furosemide. Two out of 16 additional subjects without CHF and who were not being treated with furosemide (controls) were tested for thiamine deficiency. The levels of thiamine in the urine were much higher in furosemide-treated CHF patients than in the controls. Thiamine deficiency in six patients with CHF was successfully treated by intravenous administration of thiamine. Furthermore, the function of the left heart also improved in four out of five CHF patients given intravenous thiamine. These findings show that long-term therapy with furosemide may cause thiamine deficiency, but can be successfully treated with thiamine supplements. (Consumer Summary produced by Reliance Medical Information, Inc.)

Congestive heart failure, Vitamin B1 deficiency, Thiamine deficiency, Furosemide

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Ventricular tachycardia after soccer ball blow to the chest: first manifestation of arrhythmogenic right ventricular dysplasia in two brothers

Article Abstract:

Arrhythmogenic right ventricular dysplasia (ARVD) is a heart disorder of unknown origin characterized by abnormalities of the right heart ventricle and life-threatening abnormal heart rhythms (arrhythmias). ARVD may result in sudden death in young persons. Cases are described of two brothers who developed ventricular tachycardia, a rapid heart rate arising in the ventricles, and fainting (syncope) after a soccer ball blow to the chest. One brother experienced the attack at 11 years of age, and responded to the anti-arrhythmic agent lidocaine. He was later found to have abnormalities of the right ventricle, a normal left ventricle, and normal coronary arteries. The boy was discharged and treated with the drug amiodarone to control the arrhythmias. His brother suffered an attack at the age of 24 years, and normal heart rhythm was restored by a 50-joule electrical shock. This brother had abnormalities of the right heart ventricle, as well as the left ventricle, and arrhythmias. When a study was undertaken to assess the entire family, the father, another brother, and two sisters were found to have heart disorders and/or arrhythmias. The cases of the two brothers are unique in that ventricular tachycardia and syncope were triggered by a mild blow to the chest. A possible mechanism for the development of ventricular tachycardia after a blow to the chest is discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Abnormalities, Arrhythmia, Ventricular tachycardia, Heart ventricles

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